Whose interests does the Royal College of Psychiatrists really serve?

When you consult the Royal College of Psychaitrists’s website it proclaims that one if its primary aims is to ‘improve the mental health of individuals, their families and communities’[i]– thus, to act in the public interest.

Recent events at the Royal College put that proclamation in serious doubt. The first concerns the College’s public position on the recent Cipriani et al. study on antidepressants[ii]; a study which, as an editorial in the British Medical Journal has reiterated, simply confirms what other meta-analyses have long shown: that antidepressants have no clinically significant benefits over placebo for most people. So why did the Royal College publically declare that this study will ‘finally put to bed the controversy over antidepressants’; [iii] a claim unsupported by Cipriani’s study?

As the BMJ confirms: ‘[Cipriani’s et al] meta-analysis does not answer key questions about the use of antidepressants, including their effect on milder forms of depression, their effects beyond eight weeks of treatment, the harms associated with specific agents and their magnitude, and the effectiveness of antidepressants outside the confines of randomised trials. It did not consider the long-term adverse effects of antidepressants, the likelihood of withdrawal symptoms when treatment stops…'[iv]

In short, far from ‘putting to bed the controversy over antidepressants’, this study deepens it, as subsequent events confirm.

This concerns a further attempt by the Royal College to once again, in my view, promote these drugs to the public – this time by downplaying their harmful effects. This was exposed when CEP wrote a letter to The Times[v] pointing out the limits of the Cipriani study, and stating – quite rightly – that the drugs can have severe withdrawal effects for many people.

The College’s response (also in The Times) declared we were wrong about withdrawal: ‘We know’ they contended, ‘that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’.[vi]

When campaigners pointed out that the College’s own research (published on the College’s own website) contradicted this two-week claim, within 24 hours the College had removed that research, on the grounds that it was ‘out of date’. What was meant by its being ‘out of date’ has bemused the scientific community, as clearly no subsequent research has emerged to contradict what the now buried research showed: that around 1/3 of withdrawal patients experience withdrawal effects beyond 2 months. In fact, the research we currently have exposes the two-week claim as patently false.

What these two events expose for me is something I have believed for some time: that the interests of the College trump the publics’ when it comes to the truth about psychiatric drugs. In my view, because the College has hitched its status and legitimacy to the idea that these are highly safe and effective drugs (an idea the College has successfully promoted for many years to the public, the media, the mental health and primary care sectors), anything emerging that contradicts this view is either ignored, dismissed or down-played. Self-preservation, it seems, is what matters most.

What recent events show, therefore, is that we all must redouble our efforts to demand that drug debates honour the evidence, and that professional bodies put the public interest above their own. We must reject non-evidence based arguments, such as fallacious ‘appeals to clinical experience’ and we must stand tough before the increasing number of ad hominem dismissals now being issued by College luminaries (denigrating as ‘pill-shamers’ those who would advance evidence-based criticisms of antidepressants).

To quote Barack Obama, when people go low we must go high, and there is nothing higher than holding those who speak untruth to account. Let us stick to the evidence and fight for people in need, however our opponents may act.

16 Responses to Whose interests does the Royal College of Psychiatrists really serve?

This is an excellent piece – the Myth of the Chemical Cure (Moncrieff, 2008) has been public knowledge or 10 years – no reputable refutation of the myth has been advanced. Worse, Whittaker, supported by the Harvard Centre for Ethics, accuses the psychiatric profession of ‘institutional corruption’ – a damning indictment, for which answers are desperately and urgently called for. What will enlighten this dogmatic myopia?

Ref Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform by : Robert Whitaker and Lisa Cosgrove

Spot on. Go high. I actually think the Science Media Centre extracted statements from experts that none of them can now be happy with looking back now. Prof David Taylor’s “much better than placebo”, looks daft and I’m sure we won’t find that statement getting into the Maudsley guidelines.

Even one of the authors, John Ioannidis, seems to think something is up, because he said “I am afraid that some news stories gave very crude interpretations that may be misleading, especially when their titles were too absolute, like ‘the drugs work’, ‘the debate is over’ and so forth” .

Whilst I agree with your comments I think you might reconsider this statement:
“We must reject non-evidence based arguments, such as fallacious ‘appeals to clinical experience’”

There is no epistemological qualitative difference between RCTs and clinical experience. In other words rating scales and scores generated as part of controlled trials are not superior in scientific meaning or validity to careful clinical observation. I think this widespread denigration of “clinical experience” as being somehow inferior is seriously misguided and helps to legitimise the hegemony that guidelines (derived from RCTs) fallaciously enjoy.

As I have suggested before, this can be regarded as a kind of intellectual fascism, and I think it encourages an unthinking adherence to guidelines, at the expense of individual tailoring of treatment needs.

I am sure clinical experience is extremely important but with regard to withdrawal symptoms and iatrogenic harm from antidepressants, those with clinical experience seem to have little awareness of what is going on or they are aware but do not care to admit it. Patients cannot find doctors who even recognise the adverse effects of these drugs let alone do anything about them. When doctors such as Prof Clare Gerada state on national radio that in her clinical experience antidepressant withdrawal is largely unproblematic one has to question the value of such pronouncements. She made a similar statement about benzodiazepine withdrawal on Radio 4 in 2011, despite all the evidence amassed over many years to the contrary. And when Prof Wendy Burn states on Twitter that she has no awareness at all of the difficulties with antidepressant withdrawal one really has to question the veracity of such statements.

I am sure we are in agreement. I speak with the experience of a retired specialist psychiatrist; however, when people come from different angles, knowledge bases, and experience, there is fertile ground for misunderstanding. I expect many experienced clinicians would, like me, agree that withdrawal symptoms, and many other problems, are greater than supposedly scientific studies suggest.
And I am sure you have a point that there are some “… with clinical experience [who] seem to have little awareness”, even if that is a generalisation. Whether observations come from reports of patients themselves, or from clinicians’ experience of helping patients, the point is that those observational experiences cannot be relegated to the status of second-rate evidence and are not ‘trumped’ by supposedly scientific controlled trials (which are just another form of observational experience – i.e. there is no qualitative epistemological difference).
So, anyone who hears a doctor arguing that their experience as a patient cannot be right because studies show… should be empowered by knowing that their interlocutor does not understand science. That does not mean that everything on Internet forums must be true, because, of course, much of it is bad observation, just as many RCTs are bad science.
I have written extensively about the many problems, including fraud and deceit, involved in such RCTs on my website (psychotropical), for anyone wishes to read in greater depth.

Thank you James for this excellent piece. It was with huge relief that I discovered CEP a few years ago as I had previously felt I was ploughing a lone furrow in challenging the accepted, predominant biomedical model of psychiatric practice and rigid hierarchical structure in adult mental health services that was clearly failing and damaging my son. It would be so good if more clinicians had the courage to see that there are available to them effective, non-medical approaches that not only would improve clinical outcomes but would also increase job satisfaction for mental health professionals, as evidenced by the Finnish Open Dialogue approach. I have come across many caring, hard working staff who could be much more effective using more democratic, non-medical paradigms of care, training for which is available in the UK.

Thanks Gillman, you make a good point. I suppose I was referring to statements such as those recently made on the Today Programme by Claire Gerada (when in debate with John Read), where she dismissed our claims about withdrawal on the basis of her 30-year clinical experience – her experience taught her we were wrong. The fact that doctors used to swear by bloodletting (because in their experience it worked) exposes the weakness of such ‘appeals to experience’ (it was good to hear John Read putting to right on this matter).

As a mere patient whose life is now essentially over due to iatrogenic harm, I have to agree with this assessment. I have little better to do than observe the behaviour of RCPsych on Twitter and elsewhere and it is very clear its over-arching interest is to protect and promote its own image and its own ideology. It makes no attempt to inform the pubic and usually ignores questions which asked for research evidence on Twitter. It promotes antidepressant drugs, just as any commercial company would promote its most lucrative products, never informing the public that the product is in fact seriously flawed. It dresses this up as being concerned for patients.

I observed the denigration of the Panorama Programme, Prescription for Murder?, last year before it was even aired. I am sure the public was perfectly able to asses the merits of the programme for themselves. It was both informative and balanced, unlike RCPsych’s pronouncements against it. The Twitter Q&A session afterwards held by RCPsych singularly failed to answer the vast majority of questions posed by patients and clearly there had never been any attention to engage with the public.

RCPsych seems incapable of entering into any real discussion about scientific evidence unless it happens to be in favour of its own arguments, i.e. the drugs are “safe and effective”, they “save lives” etc etc. RCPsych claims it is concerned about patients but it seems this concern is not genuine. If it was indeed concerned about patients, it would be concerned about all patients i.e. those who are depressed, those who are dependent on the drugs, those who are harmed by the drugs and those who die because of the drugs. I would like to know how many lives have been saved and how many patients now live intolerable lives because of the drugs or who have in fact died because of the drugs.

The media hype around the Lancet paper was astonishing and the subsequent letter to the Times even more so. Surely Profs Burn and Baldwin must be aware of the Pubic Health England year long review of drugs of dependence, including antidepressants. Are they unaware of the 6 year research project at Southampton University into antidepressnat withdrawal which will cost the taxpayer millions of pounds? Why was a perfectly reasonable document re antidepressant withdrawal removed from their website? The survey results were presented in a perfectly acceptable manner. Prof Wendy Burn said she did not of its existence until patients informed her via Twitter. Indeed, she also said that she has no experience of patients have difficulty with antidepressant withdrawal which I find very hard to believe.

I have observed comments on Twitter such as the current complaint is not “good form”, it will shut down public debate. It seems to me that the constant public debate has done absolutely nothing for the prescribed dependent and harmed community because those who control the debate have absolutely no interest whatsoever in doing so. Indeed it is hard pressed to even acknowledge our existence. Another psychiatrist posted that he did not know what all the fuss was about, withdrawing patients off all drugs of dependence was quite easy. How astonishing then that so much public money is being spent on this issue. He included benzodiazepines, gabapentinoids in his assertions. A neuropsychologist posted that the online horror stories about the drugs were fiction and down to scientology but when challenged she very quickly blocked about six members of the prescribed harmed community, including myself. Another psychiatrist posted that he was on an antidepressant and would be for the rest of his life. When pressed, he said he had tried three times to withdraw but was unsuccessful. And he would rather be on BAD drugs for the rest of his life than be without them. He blocked me when I forwarded his tweet to politicians at the Scottish Parliament. Perhaps he blocked them also so they could not see what he had written.

Everything I have observed over the past year or so suggests to me that RCPsych is only interested in promoting its own interests and is not interested in informing the public or indeed patients about the facts around antidepressants. This has huge implications for patients who are seeking help for depression. Psychiatrists and GPs are likely to be providing patients with biased information not supported by scientific evidence making informed consent impossible and therefore subsequent legal action very likely when patients find themselves harmed. This is a situation created entirely by the profession itself.
The fact that most psychiatrists refuse to engage on Twitter when asked simple questions and the silence from RCGP on the whole issue of antidepressant dependence leaves the observer wondering what it is that everyone is trying to hide.

Beneficial effects are over-played, based on industry-sponsored, ghost-written and data-managed clinical trials.
Many such trials have clearly defined methodological failures, and there is increasing, published evidence of academic malfeasance.

Common psycho-neurological brain and multi-systems toxicities are
causing life-changing morbidities. These toxic effects are vulnerable to misdiagnosis and under-reporting.

It seems conceptually extremely difficult for advocates and prescribers of psychotropic drugs in general -(and SSRI/SNRIs in particular) – to accept that these drugs cause changes in behaviour and personality in a significant, vulnerable group of those treated.

This includes many who accept these drugs for non-depressive conditions.

In the most vulnerable, these prescription psychiatric drug-induced personality and behavioural ADRs are reported to initiate violence against self and others.

Such personality and behavioural ADRs are vulnerable to misdiagnosis as “co-morbid”, “emergent” or “unmasked” serious mental illnesses.

In summary:
Serious and life-threatening adverse reactions to psychiatric drugs cause iatrogenic changes in thinking, emotions, and behaviour which are associated with distress and problems functioning in social, working and/or family activities.

An open, scientifically robust, and ethically based acknowledgement of the physical, emotional, psychological and social devastation of lives caused by psychiatric drug toxicities is dependent on prescribers listening to, and understanding the suffering of those persons so affected. Those who are currently rejected and isolated.

Listening to these injured people (and to their loved ones and families) without disbelief, arrogance and rejection is mandatory.

“Listen to your patient, he is telling you the diagnosis”. –
Sir William Osler.

I too am a mere patient. My life and that of my now ex-husband have also been irreparably damaged by 12 years of anti depressants prescribed by a Harley Street psychiatrist. These drugs were a sticking plaster over underlying issues which were never addressed in that period, indeed they prevented them from being addressed. The man was a bully and we could not afford his services anyway. We should not have been referred to him but were young enough and and naive enough to place unquestioning trust in older professionals. Knowing what we know now, we would not go anywhere near the man.

I also listened to Dr Clare Gerada with disbelief on Radio 4 the other day and was saddened to read Mind’s pronouncement on the same subject: the withdrawal effects of the antidepressants I took were highly unpleasant and it was extremely difficult to stop taking them. “i was lucky” in that I found a brilliant osteopath who took blood samples to establish what my body was lacking and recommended vitamin and mineral supplements to help me through this period. This was also expensive, so unfortunately would not be an option available to all.

I was cheered by this piece as it gives me hope that the lives and education of fewer people will be squandered by antidepressants in the future. Thank you very much.

I wonder how – or indeed if – actual ‘patient experience evidence’ is ever recorded and taken into consideration? Or is ‘clinical evidence’ just the opinions/perceptions recorded by doctors/psychiatrists? And/or perhaps collected (phama driven) patient self-report questionnaire data?
Our Scottish petition is gathering a very significant body of such evidence.
Third Force News has today published an article which includes a link to our Recovery and Renewal Scottish Public Petition PE01651.http://thirdforcenews.org.uk/tfn-news/support-call-for-those-struggling-with-prescription-drugs#r6EcogzzB8y3lsbZ.99

I have added the following comment:
At NHS Scotland Health’s Suicide Prevention engagement event in Glasgow on 15 March 2018 one of the references in the pre-meeting briefing was the ScotSID report, published November 2017, ‘A profile of deaths by suicide in Scotland 2009-2015’. This report was quoted in the introduction to the discussions and the point picked out that 30% of those who took their own lives had NOT had any contact with NHS healthcare services (including GP) in the previous 12 months. We were asked to consider how these (30%) of people could be could be reached and ‘helped’ by NHS and other services.
In the actual Suicides report summary (on p.7) it is reported that “Over half (59%) had at least one mental health drug prescription dispensed within 12 months of death. Over four out of five (82%) of these individuals were prescribed an antidepressant drug, alone or in combination with other medication”.
The report’s final conclusion, p54, includes the statement: “the major challenge is the link between the occurrence of suicide and the previous contact with healthcare services and receipt of medication used to treat mental ill-health.”
The following point has been made to me by a patient in Scotland: “Perhaps a study into the numbers experiencing suicidal thinking (from GP and psychiatric patient records) would be a more accurate measure of how appalling these anti-depressant drugs can be for so many patients. Only one thing can be worse than suicide, and that is permanently living with suicidal thoughts – caused by a prescribed medication.”

I think that the College has a responsibility to the GMC (and by extension to the general public) that its members are safe and competent in managing physical co-morbidities in their patients.

Of course this includes ensuring the cardiac and neurological safety of patients taking antidepressant medications as well as safe withdrawal, which on occasions can be risky and prolonged in my clinical experience.